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MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1 MAGI-BASED ELIGIBILITY VERI Column1 Column2 Column3 Column4 Column5 Column6 Column7 (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Kansas Last Updated: (mm/dd/yyyy) 04/10/2018 ification Procedures for Factors of Eligibility n/a Eligibility Factor Self-Attestation Accepted without Additional Verification (Y/N) Self-Attestation Accepted with Post-Eligibility Verification (Y/N) Electronic Data Source Used (Y/N) Reasonable Compatibility Standard Used Specify Reasonable Compatibility Standard for Income Ask for a Reasonable Explanation from the Individual (Y/N) Paper Documentation Required from the Individual (Y/N) Comments Income* NO NO YES Percent Threshold 20% YES YES A Reasonable Compatibility test is conducted by KEES and if the income is reasonably compatible, verification is not required. For all income types, income verification may be obtained through a non-medical KEES case if timely verification exists in the electronic case file. For unearned ncome, individual attestations are verified against payer interfaces (e.g. Social Security, Unemployment Comp and KPERS (state retirement system)). A reasonable explanation and/or documentation is not required from the consumer unless the attested amount is inconsistent with the payer interface. Documentation is always required for annuities, trusts, contract sales, insurance pyament, Railroad Retirement, Rental Income and Oil Royalties/Mineral Rights as no data source exists for these income types. Self- attestation will be taken on most other unearned income. For earned income, the attested amount will be used if electronic data available from TALX/The Work Number and Wage information from the KS Department of Labor is reasonably compatible with the attestation. Reasonable compatibility exists if the applicant/recipient attests to income below the applicable standard but the data sources indicated income above the applicable standard, and the difference between the two is 20% or less. If an individual attests to income above the highest applicable standard for the individual and the data sources indicate income below the standard, client attestation will be accepted and the person will be determined ineligible for Medicaid and CHIP.

For self-employment, a tax return will be requested if it includes the specific self-employment income and a tax return on that income was filed in the previous year and if it is representative of the current business arrangement. If a tax return is not available employment records will be requested. For special situations, such as homelessness, domestic violence and natural disasters, the agency will attempt to verify income according to current policy by using automated sources, information currently known to the agency and, if necessary, verification from the consumer. However, if the consumer indicated verification is not available due to the situation, verification may be suspended and self-attestation of income accepted if the report is consistent with the consumers circumstances. Traditional verification may be required at the next annual redetermination if the individual's circumstances have changed. .